Echocardiographic measurements in normal Chinese adults (EMINCA) II focusing on left ventricular and left atrial size and function by three-dimensional echocardiography
image: Fig 1
Credit: Yingbin Wang, Yu Zhang, Guihua Yao, Hong Tang, Lixin Chen, Lixue Yin, Tiangang Zhu, Jianjun Yuan, Wei Han, Jun Yang, Xianhong Shu, Ya Yang, Yulin Wei, Yanli Guo, Weidong Ren, Dongmei Gao, Guilin Lu, Ji Wu, Hongning Yin, Yuming Mu, Jiawei Tian, Lijun Yuan, Xiaojing Ma, Hongyan Dai, Yunchuan Ding, Mingyan Ding, Qing Zhou, Hao Wang, Di Xu, Mei Zhang, Yun Zhang
The study focuses on establishing normative values for left ventricular (LV) and left atrial (LA) size and function using three-dimensional echocardiography (3DE) among healthy Han Chinese adults. This prospective, multicenter research was conducted across various age groups and aimed to account for ethnic variations not covered by existing American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) guidelines. The investigation revealed significant differences in cardiac measurements when compared to global standards, underscoring the need for population-specific norms.
The research methodology involved a meticulous selection process of 866 healthy volunteers from 28 echocardiographic labs across China, ensuring equal gender and age distribution. Participants underwent standardized 3DE imaging, with data analyzed by experienced echocardiographers at a core laboratory. The study utilized two types of ultrasound instruments to acquire data and employed a vendor-independent offline workstation for analysis, ensuring a comprehensive and unbiased approach.
Results from the study indicated that 3D-LV and 3D-LA measurements varied significantly with sex and age. Women exhibited smaller LV dimensions compared to men, and both showed a decrease in LV size with age. Global longitudinal strain (GLS) and global circumferential strain (GCS), key indicators of cardiac function, were also found to differ between sexes. Notably, the study found that the current ASE/EACVI guidelines and World Alliance Societies of Echocardiography (WASE) standards did not accurately represent the measurements from the Chinese population, with a considerable portion of healthy volunteers being potentially misclassified as abnormal based on these criteria.
The study's findings are crucial for clinical practice as they advocate for the development of sex-, age-, and ethnicity-specific reference ranges for 3D echo measurements. This could lead to more accurate diagnoses and better patient management, particularly in the context of conditions affecting cardiac structure and function. The research also highlighted the importance of high intra- and inter-observer reproducibility in echocardiographic measurements, ensuring reliable and consistent results.
Despite its robust methodology, the study acknowledged limitations, including the focus on Han Chinese adults, which may limit the generalizability of the findings to other ethnicities. Additionally, the use of a single offline workstation for analysis may not reflect the diversity of tools used in clinical settings. Despite these considerations, the study's comprehensive approach and significant findings contribute valuable insights into the field of echocardiography and have the potential to influence clinical guidelines and practices.
In conclusion, the EMINCA II study provides a comprehensive set of normative values for 3D echo measurements specific to Han Chinese adults, offering a scientific basis for more accurate and personalized cardiac assessments. The study's recommendations for ethnicity-specific standards could lead to improved diagnostic accuracy and patient outcomes in cardiovascular medicine.